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Published on: June 2, 2014
Clinical characteristics and short-term outcomes of migraine with patent foramen ovale: a comparative study
Yongfei Sun1, Nanqu Huang2, Fei Feng3
1Department of Vascular Ultrasound, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, Guizhou, China.
Objective:
To analyze the clinical features and prognosis of migraine with PFO and explore their short-term prognostic factors.
Methods:
This study enrolled patients with migraine (MH) and patients with migraine with patent foramen ovale (MH-PFO) who were treated at two hospitals affiliated with Zunyi Medical University (December 2021-October 2022). The general information of the two groups of patients was compared, and the clinical characteristics of the patients with MH-PFO were analyzed. All participants underwent standardized follow-ups at 1 and 3 months posttreatment; the patients were assessed using the Headache Impact Test-6 (HIT-6), the Zung Self-Rating Anxiety Scale (SAS), and the Zung Self-Rating Depression Scale (SDS). Prognostic analysis included multivariate logistic regression.
Results:
239 patients with migraine completed the follow-up (MH group: 67; MH-PFO group: 172). Compared with the MH group, the MH-PFO group presented significantly earlier symptom onset (P < 0.001), a greater incidence of migraine aura (36.6% vs. 3.0%), a greater family history of migraine (28.5% vs. 9.0%), and elevated HIT-6/SAS/SDS scores and D-dimer levels (all P < 0.05). The medication response was poorer in the MH-PFO group (P < 0.05). Compared with medication, surgical intervention in the MH-PFO group reduced the severity of headache and anxiety/depression (all P < 0.05). Migraine with aura (1 month: OR = 0.159; 3 months: OR = 0.218), intrinsic right-to-left shunt (1 month: OR = 0.228; 3 months: OR = 0.060), and higher baseline HIT-6 scores (1 month: OR = 0.904; 3 months: OR = 0.879) were consistent predictors of reduced headache severity at the 1- and 3-month follow-ups postsurgery (all P < 0.05). A composite model integrating these factors demonstrated robust predictive accuracy for headache improvement after surgical treatment (AUC 0.84-0.89, P < 0.05; 0.7 < AUC < 0.9, all P < 0.05).
Conclusion:
Compared to patients with MH, patients with MH-PFO have earlier symptom onset, higher rates of migraine aura, increased headache severity, more severe anxiety/depression, elevated D-dimer levels, and a greater incidence of family history of migraine. These patients respond more poorly to medication than patients with MH do. PFO closure has superior short-term efficacy in patients with migraine aura, intrinsic shunt, and high baseline HIT-6 scores (HIT-6 ≥ 59.5), highlighting the need for tailored therapeutic strategies.
Insights
Patients with migraine and patent foramen ovale (PFO) experience earlier onset, more severe symptoms, and poorer medication response. Surgical PFO closure shows superior short-term efficacy, especially for those with aura, shunt, and high baseline headache impact.
Area of Science:
- Neurology
- Cardiology
- Medical Diagnostics
Background:
- Migraine is a prevalent neurological disorder.
- Patent Foramen Ovale (PFO) is a cardiac anomaly associated with various neurological conditions, including migraine.
- Understanding the clinical characteristics and prognostic factors of migraine with PFO is crucial for effective management.
Purpose of the Study:
- To analyze the clinical features and prognosis of migraine patients with PFO (MH-PFO).
- To identify short-term prognostic factors for patients with MH-PFO.
- To compare the efficacy of medication versus surgical intervention for MH-PFO.
Main Methods:
- A comparative study of 239 migraine patients (67 MH, 172 MH-PFO) treated between December 2021 and October 2022.
- Standardized follow-ups at 1 and 3 months post-treatment assessing Headache Impact Test-6 (HIT-6), anxiety (SAS), and depression (SDS) scores.
- Multivariate logistic regression was used for prognostic analysis.
Main Results:
- MH-PFO patients exhibited earlier symptom onset, higher incidence of migraine aura, family history, elevated HIT-6/SAS/SDS scores, and D-dimer levels compared to MH patients.
- The MH-PFO group showed a poorer response to medication.
- Surgical intervention in MH-PFO patients significantly reduced headache severity and anxiety/depression symptoms compared to medication.
- Migraine with aura, intrinsic right-to-left shunt, and high baseline HIT-6 scores predicted reduced headache severity post-surgery.
Conclusions:
- Migraine with PFO is associated with distinct clinical features, including earlier onset, increased aura, higher symptom burden, and poorer medication response.
- PFO closure demonstrates superior short-term efficacy over medication for MH-PFO patients.
- Tailored therapeutic strategies are necessary, considering factors like aura, shunt presence, and baseline headache impact scores for optimal outcomes.
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